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It has surprised me a few times when I've seen successful massage therapists state that they do not feel anything while massaging clients. Obviously, the job gets done either way, but I am curious, who here can find the pain by touch alone? Or do you need the client to tell you where it hurts?

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Hi, Linda!

For me, there's no definite.  Most of the time I can find the TP by touch, but even so, if the client doesn't react with even a slight twitch, I ask for confirmation.  But I said "most" not all.  I always tell them that if I don't notice a tender spot to please speak up or lift a hand.

There's two types who can make the treatment problematic, the macho guy or gal who barely reacts and denies that there's pain,  and those who just can't relax.  You know the type-- you can spend an hour working an area (the upper traps, the thighs, etc)  before the tissue begins to soften, then the second you move to another area, the HT moves back in.  Some of them, it's likely a psychological issue in their private life that keeps them tense; others, it seems to be subconscious fear of being thought "flabby".   


Hi Gary!

Sorry, what is HT?

I only work on problems like RLS, sciatica, Plantar Fasciitis, etc., so, I don't have to deal with clients who have macho issues, they have already accepted that they are hurting. And, I think my being bigger than a lot of my clients makes it easier for the ones who are self-conscious to be comfortable, LOL!

Once the client has helped you pinpoint the exact location of pain, are you able to feel the difference between that spot and one that isn't hurting? 
 Gary W Addis said:

Hi, Linda!

For me, there's no definite.  Most of the time I can find the TP by touch, but even so, if the client doesn't react with even a slight twitch, I ask for confirmation.  But I said "most" not all.  I always tell them that if I don't notice a tender spot to please speak up or lift a hand.

There's two types who can make the treatment problematic, the macho guy or gal who barely reacts and denies that there's pain,  and those who just can't relax.  You know the type-- you can spend an hour working an area (the upper traps, the thighs, etc)  before the tissue begins to soften, then the second you move to another area, the HT moves back in.  Some of them, it's likely a psychological issue in their private life that keeps them tense; others, it seems to be subconscious fear of being thought "flabby".   

Some clients like to go into detail about their pain. I let them and encourage it because it is part of their therapy for letting go. I depend on what I feel almost entirely. As I go I will ask for input as to what they feel as I move along. This is more for their ease of mind then benefit in locating the problem. I am usually ahead of them anyway. Experience and feel is what searches out the problem and addresses it. What do I feel? Very tiny changes in tension that give the signals as to what goes on under the skin. A common comment clients make is; "how did you know that was there? I didn't even realize  it. I don't use Trigger Points (seems the definition has changed over the years to include several things) and I can't name the location often without consulting an anatomy book, but I do find it quickly with no questions asked.

For years clients would ask, "How did you know that hurt when I didn't know it hurt". At first I thought I had "Super MT Senses", (LOL!) then I realized I was feeling differences in tissue density (TD). I assumed for a while that they were related to the tension caused by the pain, but, if it didn't hurt before I came along and exposed it, why tense up? Of course, just because we are unaware of, "issues in the tissues", doesn't mean the body and mind are not. We all know that people show up tense, tight, and achy, then leave relaxed and looser, but I came to realize that you can absolutely measure and record the level of density that exists, before and after treatment. I found that there is ALWAYS an elevation of TD in painful tissues, and as the pain goes away, so does the TD. It doesn’t matter what the cause of the pain is, if the focus is put on restoring the TD, then the client is relieved, and the therapist is able to accurately document the condition and results.

 
Daniel Cohen said:

Some clients like to go into detail about their pain. I let them and encourage it because it is part of their therapy for letting go. I depend on what I feel almost entirely. As I go I will ask for input as to what they feel as I move along. This is more for their ease of mind then benefit in locating the problem. I am usually ahead of them anyway. Experience and feel is what searches out the problem and addresses it. What do I feel? Very tiny changes in tension that give the signals as to what goes on under the skin. A common comment clients make is; "how did you know that was there? I didn't even realize  it. I don't use Trigger Points (seems the definition has changed over the years to include several things) and I can't name the location often without consulting an anatomy book, but I do find it quickly with no questions asked.

I think we may be on the same wave length. Perhaps density is the difference but there are two things I notice tense tissue and lax tissue and both cause problems for clients and can be corrected.

Since pain is subjective and reported differently by different individuals and the brain reports only limited areas of pain at a time, I prefer to rely on what I feel more than what I am told. It also bypasses the machismo reflex of pain denial.


Linda LePelley, RN, NMT said:

For years clients would ask, "How did you know that hurt when I didn't know it hurt". At first I thought I had "Super MT Senses", (LOL!) then I realized I was feeling differences in tissue density (TD). I assumed for a while that they were related to the tension caused by the pain, but, if it didn't hurt before I came along and exposed it, why tense up? Of course, just because we are unaware of, "issues in the tissues", doesn't mean the body and mind are not. We all know that people show up tense, tight, and achy, then leave relaxed and looser, but I came to realize that you can absolutely measure and record the level of density that exists, before and after treatment. I found that there is ALWAYS an elevation of TD in painful tissues, and as the pain goes away, so does the TD. It doesn’t matter what the cause of the pain is, if the focus is put on restoring the TD, then the client is relieved, and the therapist is able to accurately document the condition and results.

 
Daniel Cohen said:

Some clients like to go into detail about their pain. I let them and encourage it because it is part of their therapy for letting go. I depend on what I feel almost entirely. As I go I will ask for input as to what they feel as I move along. This is more for their ease of mind then benefit in locating the problem. I am usually ahead of them anyway. Experience and feel is what searches out the problem and addresses it. What do I feel? Very tiny changes in tension that give the signals as to what goes on under the skin. A common comment clients make is; "how did you know that was there? I didn't even realize  it. I don't use Trigger Points (seems the definition has changed over the years to include several things) and I can't name the location often without consulting an anatomy book, but I do find it quickly with no questions asked.

I go by the feeling of the tissue beneath my hands.  Much of the time I work with my eyes closed and simply follow my hands to the areas needing work.  When asked by clients how I know the area needs work or is painful my reply is the tissue simply feels different than it should feel.  Your description of tissue density makes sense to me.  

Yes, lax TD is found over deeper, hyperdense tissues. I believe that in the process of condensing, those deeper tissues become separated from and lose their connection to the more superficial tissues, which, no longer fully attached, hang and sag. Hello wrinkles! Fortunately, we are not machines that wear out. Once the hyperdensity is restored, the hypodense areas are able to reconnect and recover.

I do rely a lot on what my client tells, me, but it is while I am  verifying it with what I feel in the tissues. 

Yes, I think we are on the same wavelength also. :)

We may use different descriptive words, but we are all working on the same things. My purpose for developing a system to assess, measure, and record TD is to provide what we have needed for decades. Proof. Documentable, understandable, undeniable proof.
 
Daniel Cohen said:

I think we may be on the same wave length. Perhaps density is the difference but there are two things I notice tense tissue and lax tissue and both cause problems for clients and can be corrected.

Since pain is subjective and reported differently by different individuals and the brain reports only limited areas of pain at a time, I prefer to rely on what I feel more than what I am told. It also bypasses the machismo reflex of pain denial.

 

I think a lot of us do the same, Kathy! I suspect that we know when what we are feeling is wrong, even if we haven't put words to describe it, and we also know what to do to make it better.
 
Kathy Mackay said:

I go by the feeling of the tissue beneath my hands.  Much of the time I work with my eyes closed and simply follow my hands to the areas needing work.  When asked by clients how I know the area needs work or is painful my reply is the tissue simply feels different than it should feel.  Your description of tissue density makes sense to me.  

Soory, Linda-- referring to hypertonicity.  my experience that even those who suffer pretty intense neuromuscular pain can be psychologically unable to relax.  Thank goodnes not many like that.

Linda LePelley, RN, NMT said:


Hi Gary!

Sorry, what is HT?

I only work on problems like RLS, sciatica, Plantar Fasciitis, etc., so, I don't have to deal with clients who have macho issues, they have already accepted that they are hurting. And, I think my being bigger than a lot of my clients makes it easier for the ones who are self-conscious to be comfortable, LOL!

Once the client has helped you pinpoint the exact location of pain, are you able to feel the difference between that spot and one that isn't hurting? 
 Gary W Addis said:

Hi, Linda!

For me, there's no definite.  Most of the time I can find the TP by touch, but even so, if the client doesn't react with even a slight twitch, I ask for confirmation.  But I said "most" not all.  I always tell them that if I don't notice a tender spot to please speak up or lift a hand.

There's two types who can make the treatment problematic, the macho guy or gal who barely reacts and denies that there's pain,  and those who just can't relax.  You know the type-- you can spend an hour working an area (the upper traps, the thighs, etc)  before the tissue begins to soften, then the second you move to another area, the HT moves back in.  Some of them, it's likely a psychological issue in their private life that keeps them tense; others, it seems to be subconscious fear of being thought "flabby".   

What y'all are calling difference in tissue density is a good descrption of what I feel pretty well--what Shiatsu calls tsubo's jitsu and kyo.  The "hollow" spot are harder for me to find by touch alone, it often surprises me that the client reports tenderness there, sometimes intense pain.  The other kind, I can find with touch.  

        The hypertonicity I referred to is like plates of armor, especially in the upper traps.  I look to antagonists first for the cause; if no TPs (or if you prefer "tissue density issues" there) I work inward toward the iron tissue.  Once it is relaxed I can scan for the tender spots, which if I find one or more will be deeper than the traps.  

 

But this one guy, he is like a knight in hairy armor. in his 50s, tall, looks flabby but he tenses when the limbs, pecs, back are touched.  Trying to stretch his hams, you want to reach for a hammer!  Tell him 20 times to relax, he will, but only for a second.  His SOAP charts are criss-crossed with  hypertonicity (HT) marks, hardly ever is a TP noted by anyone who has worked on him. 

A successful competitive bodybuilder  in a former life, two years ago at the start of massage school I became a weight trainer again after 24 years away from the gyms--my first few times on the table, I too was a knight in hairy armor.  The "big guns" (big biceps) guys are always aware of their bodies...when they get out of bed in morning, they stand before a mirror and put on their armor...the lats tighten and spread, the glutes tighten, the abdominals and obliques and serratus combine to shrink waist size by ten inches.  So, sometimes one must learn to relax.   

Daniel Cohen said:

Some clients like to go into detail about their pain. I let them and encourage it because it is part of their therapy for letting go. I depend on what I feel almost entirely. As I go I will ask for input as to what they feel as I move along. This is more for their ease of mind then benefit in locating the problem. I am usually ahead of them anyway. Experience and feel is what searches out the problem and addresses it. What do I feel? Very tiny changes in tension that give the signals as to what goes on under the skin. A common comment clients make is; "how did you know that was there? I didn't even realize  it. I don't use Trigger Points (seems the definition has changed over the years to include several things) and I can't name the location often without consulting an anatomy book, but I do find it quickly with no questions asked.

I have not had the opportunity to work on a (currently active) bodybuilder other than feet, but there are a lot of oil rig workers and pipe fitters around here, I've had a few cases of peripheral neuropathy on guys whose biceps are huge. It takes longer to get through to the right spot. And it is harder to get them relaxed, I have to shake the muscle and tell them I need it to be like a jello jiggler!

"Knight in hairy armor", LOL!!

You mentioned the "hollow spot" as being more tender and painful, and I find that to be true as well. I'm convinced that it is because the localized tissues have impaired circulation and are hypo-hydrated, which results in a loss of mass and elasticity. It has dried up and shrunken to a degree, however, the nerves are still sandwiched in there. And they are not at all comfortable. The nerves, “slidey glidey” abilities are gone, movement now involves tugging and shredding. Good news is, you can restore it to normal density = normal circulation =no pain =normal function.

I have a client whose son is a bodybuilder, and he is supposed to be coming to see me soon for shoulder pains. It will be interesting to note how well he can relax. Of course, my being a non-body-builder-competitor older female may make it a lot easier.

 

 
 
Gary W Addis said:

What y'all are calling difference in tissue density is a good descrption of what I feel pretty well--what Shiatsu calls tsubo's jitsu and kyo.  The "hollow" spot are harder for me to find by touch alone, it often surprises me that the client reports tenderness there, sometimes intense pain.  The other kind, I can find with touch.  

        The hypertonicity I referred to is like plates of armor, especially in the upper traps.  I look to antagonists first for the cause; if no TPs (or if you prefer "tissue density issues" there) I work inward toward the iron tissue.  Once it is relaxed I can scan for the tender spots, which if I find one or more will be deeper than the traps.  

 

But this one guy, he is like a knight in hairy armor. in his 50s, tall, looks flabby but he tenses when the limbs, pecs, back are touched.  Trying to stretch his hams, you want to reach for a hammer!  Tell him 20 times to relax, he will, but only for a second.  His SOAP charts are criss-crossed with  hypertonicity (HT) marks, hardly ever is a TP noted by anyone who has worked on him. 

A successful competitive bodybuilder  in a former life, two years ago at the start of massage school I became a weight trainer again after 24 years away from the gyms--my first few times on the table, I too was a knight in hairy armor.  The "big guns" (big biceps) guys are always aware of their bodies...when they get out of bed in morning, they stand before a mirror and put on their armor...the lats tighten and spread, the glutes tighten, the abdominals and obliques and serratus combine to shrink waist size by ten inches.  So, sometimes one must learn to relax.    
 

I dont really feel anything in their tissues or even try too.   I can certainly feel emotional tensions that may permeate their body.. but....There is such bio- individuality and body types...I have no doubt that visual assessment and palpatory skills can be honed to a high art...but I never got into that because I found it much easier to communicate with my client as to where their pain is.. I have to make sure we are speaking the same language thats for sure..I will say.. Tell me when Im on a sore spot....Then once Im on the sore or painful area...Well, I make it history..most of the time...and if they are just in to relax and unwind, I just rub with the right pressure taking ques from their body language and so on.  I know what parts of the body that are most likely to have pain depending on what they tell me..  I know where to start looking if they say they have shoulder pain,, or low back pain and so on... And often times I go right to a painful area...cause I know where people get sore ..Been doing this long enough... lol      I added an attachment from a long time ago post of mine..  I like that kind of work...

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